Project Summary Strategies to prevent unintended pregnancies support public health by building reproductive autonomy and promoting the positive maternal and child health outcomes associated with intended pregnancies. One approach to the prevention of unintended pregnancies is through reducing health systems barriers that impede access to contraceptive services. The requirement that women obtain a prescription from a clinical provider for hormonal methods of contraception is one barrier that may not be medically necessary for safe use of methods such as the contraceptive pill. Endowing pharmacists with the authority to prescribe these relatively safe methods of contraception may increase contraceptive use and reduce unintended pregnancies, particularly among women who face undue barriers to accessing clinical services. The objective of this proposed research project is to provide scientific evidence for the effectiveness of a policy that allows pharmacists to directly prescribe hormonal contraception among Medicaid-enrolled women in Oregon. Specifically, this study will assess (1) whether women accessing pharmacist-prescribed contraception are new users of contraception or whether they are continuing users who previously had obtained prescriptions from another type of clinician; (2) whether direct pharmacy access to contraceptive services is reaching women who face the greatest barriers to accessing services, including women living in rural areas, those with the highest poverty levels, and racial and ethnic minorities; and (3) whether women obtaining contractive prescriptions from pharmacists differ in past healthcare utilization compared to other women. Linked Medicaid claims, eligibility, and provider data will be used to identify contraceptive services, demographic characteristics, and receipt of preventive care among Medicaid-enrolled women following implementation of the pharmacy access policy and in the relevant timeframe prior to implementation. Comparisons will be made between women receiving prescriptions from pharmacists to women receiving prescriptions from other types of clinicians using advanced statistical methods and taking into account variations in demographic characteristics as appropriate. Results of this study can be used to inform other state and national policy efforts to increase access to contraceptive services. Successful aspects of Oregon?s policy can be translated to other contexts, while evidence of any gaps in implementation can be used to improve future policies.